Nuclear medicine imaging of the pediatric musculoskeletal system.

Bone scintigraphy is a common pediatric nuclear medicine procedure and plays a significant role in the diagnosis of skeletal infection, trauma, and benign and malignant bone tumors. There is a complementary role for bone scintigraphy in the assessment of a child with suspected nonaccidental injury. High-quality images require careful attention to technique and positioning in children. Additional techniques such as magnification and single-photon emission computed tomography (SPECT) can be used for special indications and localization. Combined functional and anatomic imaging using SPECT/computed tomography (CT) imaging systems can improve diagnostic accuracy. Positron emission tomography (PET) using fluorine-18 fluorodeoxyglucose (FDG) is being applied with increasing frequency in the evaluation of children with malignancy. To interpret (18)F-FDG PET appropriately, it is essential to know the normal physiological distribution. Using combined (18)F-FDG PET/CT improves specificity and localization. This article reviews the common indications for bone scintigraphy and (18)F-FDG PET/CT in benign and malignant pediatric musculoskeletal disease.